|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 75741 26
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$84.08
|
| Rate for Payer: AlohaCare Medicare |
$58.92
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$64.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.92
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 75741 TC
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$84.08
|
| Rate for Payer: AlohaCare Medicare |
$78.62
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Devoted Health Medicare |
$86.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.62
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 75741
|
| Min. Negotiated Rate |
$84.08 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$84.08
|
| Rate for Payer: AlohaCare Medicare |
$137.54
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Devoted Health Medicare |
$151.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$204.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.54
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 75705 TC
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: AlohaCare Medicaid |
$160.34
|
| Rate for Payer: AlohaCare Medicare |
$190.46
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Devoted Health Medicare |
$209.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$190.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$674.00
|
| Rate for Payer: Health Management Network Commercial |
$283.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$228.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$228.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$228.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$190.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$190.46
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$545.49
|
|
|
Service Code
|
HCPCS 75705
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: AlohaCare Medicaid |
$160.34
|
| Rate for Payer: AlohaCare Medicare |
$311.71
|
| Rate for Payer: Cash Price |
$327.29
|
| Rate for Payer: Cash Price |
$327.29
|
| Rate for Payer: Devoted Health Medicare |
$342.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$311.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$674.00
|
| Rate for Payer: Health Management Network Commercial |
$463.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$374.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$374.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$374.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$311.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$311.71
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 75705 26
|
| Min. Negotiated Rate |
$121.25 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: AlohaCare Medicaid |
$160.34
|
| Rate for Payer: AlohaCare Medicare |
$121.25
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Devoted Health Medicare |
$133.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$674.00
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.25
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 75726 26
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$108.71
|
| Rate for Payer: AlohaCare Medicare |
$91.16
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Devoted Health Medicare |
$100.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.16
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 75726 TC
|
| Min. Negotiated Rate |
$86.97 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$108.71
|
| Rate for Payer: AlohaCare Medicare |
$86.97
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Devoted Health Medicare |
$95.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$245.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.97
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 75726
|
| Min. Negotiated Rate |
$108.71 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$108.71
|
| Rate for Payer: AlohaCare Medicare |
$178.14
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Devoted Health Medicare |
$195.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$381.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$213.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$213.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$213.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.14
|
|
|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 75746 TC
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$88.26
|
| Rate for Payer: AlohaCare Medicare |
$94.19
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Devoted Health Medicare |
$103.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.19
|
|
|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 75746 26
|
| Min. Negotiated Rate |
$51.72 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$88.26
|
| Rate for Payer: AlohaCare Medicare |
$51.72
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Devoted Health Medicare |
$56.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.72
|
|
|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 75746
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$88.26
|
| Rate for Payer: AlohaCare Medicare |
$145.91
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Devoted Health Medicare |
$160.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$145.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$145.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$145.91
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 75774
|
| Min. Negotiated Rate |
$62.26 |
| Max. Negotiated Rate |
$574.83 |
| Rate for Payer: AlohaCare Medicaid |
$62.26
|
| Rate for Payer: AlohaCare Medicare |
$102.26
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Devoted Health Medicare |
$112.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.83
|
| Rate for Payer: Health Management Network Commercial |
$226.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.26
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 75774 26
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$574.83 |
| Rate for Payer: AlohaCare Medicaid |
$62.26
|
| Rate for Payer: AlohaCare Medicare |
$44.72
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Devoted Health Medicare |
$49.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.83
|
| Rate for Payer: Health Management Network Commercial |
$66.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.72
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 75774 TC
|
| Min. Negotiated Rate |
$57.54 |
| Max. Negotiated Rate |
$574.83 |
| Rate for Payer: AlohaCare Medicaid |
$62.26
|
| Rate for Payer: AlohaCare Medicare |
$57.54
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Devoted Health Medicare |
$63.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.83
|
| Rate for Payer: Health Management Network Commercial |
$159.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.54
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 75630 26
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: AlohaCare Medicaid |
$99.20
|
| Rate for Payer: AlohaCare Medicare |
$90.84
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Devoted Health Medicare |
$99.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$668.03
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.84
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 75630
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: AlohaCare Medicaid |
$99.20
|
| Rate for Payer: AlohaCare Medicare |
$163.76
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Devoted Health Medicare |
$180.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$668.03
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$196.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$196.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$196.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.76
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 75630 TC
|
| Min. Negotiated Rate |
$72.92 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: AlohaCare Medicaid |
$99.20
|
| Rate for Payer: AlohaCare Medicare |
$72.92
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Devoted Health Medicare |
$80.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$668.03
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.92
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 75625 TC
|
| Min. Negotiated Rate |
$67.41 |
| Max. Negotiated Rate |
$616.85 |
| Rate for Payer: AlohaCare Medicaid |
$80.11
|
| Rate for Payer: AlohaCare Medicare |
$67.41
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Devoted Health Medicare |
$74.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.85
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.41
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 75625 26
|
| Min. Negotiated Rate |
$64.49 |
| Max. Negotiated Rate |
$616.85 |
| Rate for Payer: AlohaCare Medicaid |
$80.11
|
| Rate for Payer: AlohaCare Medicare |
$64.49
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Devoted Health Medicare |
$70.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.85
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.49
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 75625
|
| Min. Negotiated Rate |
$80.11 |
| Max. Negotiated Rate |
$616.85 |
| Rate for Payer: AlohaCare Medicaid |
$80.11
|
| Rate for Payer: AlohaCare Medicare |
$131.91
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Devoted Health Medicare |
$145.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$131.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.85
|
| Rate for Payer: Health Management Network Commercial |
$281.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$131.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$131.91
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 75605 26
|
| Min. Negotiated Rate |
$51.93 |
| Max. Negotiated Rate |
$617.27 |
| Rate for Payer: AlohaCare Medicaid |
$78.15
|
| Rate for Payer: AlohaCare Medicare |
$51.93
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Devoted Health Medicare |
$57.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$617.27
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.93
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 75605 TC
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$617.27 |
| Rate for Payer: AlohaCare Medicaid |
$78.15
|
| Rate for Payer: AlohaCare Medicare |
$77.86
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Devoted Health Medicare |
$85.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$617.27
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.86
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 75605
|
| Min. Negotiated Rate |
$78.15 |
| Max. Negotiated Rate |
$617.27 |
| Rate for Payer: AlohaCare Medicaid |
$78.15
|
| Rate for Payer: AlohaCare Medicare |
$129.79
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Devoted Health Medicare |
$142.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$617.27
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.79
|
|
|
CHG BILIRUBIN TOTAL
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS 82247
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: AlohaCare Medicaid |
$6.94
|
| Rate for Payer: AlohaCare Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$5.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.95
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.02
|
|
